Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 29:14:100204.
doi: 10.1016/j.sipas.2023.100204. eCollection 2023 Sep.

Administering prophylactic alpha-blockade to reduce urinary retention post inguinal hernia repair: A systematic review and meta-analysis of randomised control trials

Gavin G Calpin  1   2 , Alice M O'Neill  1 , Matthew G Davey  1   2 , Peggy Miller  2 , William P Joyce  1   2
Affiliations
Review

Administering prophylactic alpha-blockade to reduce urinary retention post inguinal hernia repair: A systematic review and meta-analysis of randomised control trials

Gavin G Calpin et al. Surg Pract Sci. .

Abstract

Introduction: The incidence of post-operative urinary retention (POUR) following inguinal hernia repair (IHR) is approximately 0.4% - 22.0%. POUR may lead to patient discomfort and catheter-related complications including urinary tract infection, urethral trauma, bladder overdistension and subsequent permanent bladder dysfunction. We aimed to perform a systematic review and meta-analysis of randomised control trials (RCT) evaluating the impact of administration of perioperative alpha-blockade to reduce the incidence of acute POUR following IHR.

Methods: A systematic review was performed as per PRISMA guidelines. The incidence of POUR in the alpha-blocker and control groups were expressed as dichotomous outcomes, reported as odds ratios (ORs) expressed with 95% confidence intervals (CIs) following estimation using the Mantel-Haenszel method.

Results: Eight RCTs with a combined total of 918 patients were included. Of these, 53.7% (493/918) received alpha-blockers while 46.3% (425/918) did not. Five studies used tamsulosin, two used prazosin and one used phenoxybenzamine. Overall, the prescription of prophylactic alpha-blockers in the preoperative setting significantly reduced POUR compared to the control group (7.9% (39/493) vs 21.2% (90/425), OR: 0.31, 95% CI: 0.12-0.80, P = 0.020).

Conclusion: Preoperative prescription of alpha-blockers reduced the incidence of POUR following inguinal hernia repair. The next generation of prospective randomised trials may identify which patients should be prescribed this medication prior to surgery.

Keywords: Inguinal hernia repair; Post-operative complication; Prophylactic alpha-blockade; Urinary retention.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1:
Fig. 1
PRISMA flow diagram of study identification.
Fig 2:
Fig. 2
Forest plot of post-operative urinary retention.
Fig 3:
Fig. 3
Evidence table.
See this image and copyright information in PMC

References

    1. Bay-Nielsen M., Kehlet H., Strand L., Malmstrøm J., Andersen F.H., Wara P., et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358:1124–1128. - PubMed
    1. Öberg S., Andresen K., Rosenberg J. Etiology of inguinal hernias: a comprehensive review. Front Surg. 2017;4:52. - PMC - PubMed
    1. Blair A.B., Dwarakanath A., Mehta A., Liang H., Hui X., Wyman C., et al. Postoperative urinary retention after inguinal hernia repair: a single institution experience. Hernia. 2017;21:895–900. - PMC - PubMed
    1. Baldini G., Bagry H., Aprikian A., Carli F., Warner David S., Warner Mark A. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–1157. - PubMed
    1. Koch C.A., Grinberg G.G., Farley D.R. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg. 2006;191:381–385. - PubMed

LinkOut - more resources